Disparities in developmental-behavioral diagnoses in Hispanic immigrant children: role of parent concern and screening

西班牙裔移民儿童发育行为诊断的差异：父母关注和筛查的作用

• 批准号: 10575994
• 负责人: Stacey Luen Bevan
• 金额: $ 3.38万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10575994
• 关键词: Address; Affect; Appointment; Behavior; Behavior Disorders; Behavioral; Behavioral Symptoms; Caring; Child; Child Behavior; Child Health; Childhood; Clinical; Cluster Analysis; Communities; Country; Data; Development; Developmental Disabilities; Diagnosis; Diagnostic; Diagnostic tests; Disadvantaged; Discrimination; Disease; Disparity; Disparity in diagnosis; Early identification; Equation; Equity; Ethnic Origin; Ethnic Population; Exposure to; Family; Goals; Health; Health Services Accessibility; High Prevalence; Hispanic; Immigrant; Immigrant family; Immigration; Inequality; Intervention; Knowledge; Literature; Low Prevalence; Mediating; Mediator; Modeling; National Institute of Mental Health; Outcome; Parents; Pediatric Hospitals; Pediatrics; Perception; Philadelphia; Population; Prevalence; Primary Care; Problem behavior; Process; Provider; Race; Refugees; Reporting; Research; Risk; Risk Behaviors; Sampling; Screening Result; Sensory; Services; Site; Social Conditions; Social status; Social support; Societies; Stress; Testing; United States; Visit; accurate diagnosis; autism spectrum disorder; behavioral health; burden of illness; caucasian American; clinical care; clinical diagnosis; clinical diagnostics; clinical predictors; design; disability; ethnic health disparity; ethnic minority population; experience; health care availability; health disparity; improved; instrument; low socioeconomic status; migration; parental influence; parental role; pediatrician; poor health outcome; primary care visit; psychologic; racial population; screening; secondary analysis; social; social determinants; social integration; structural health determinants; trend

PROJECT SUMMARY Developmental-behavioral disabilities are present in nearly 1 in 5 children in the United States and are among the most common concerns parents discuss at primary care visits. Autism Spectrum Disorder (ASD) is one of these conditions, which is characterized by differences in social and sensory processing. While ASD occurs in approximately 1 in 53 children, racial-ethnic groups are diagnosed at different rates. White children have the highest prevalence (2.65%), and Hispanic children are least likely to be diagnosed (1.94%). Moreover, 0.5% of Spanish-speaking children and 0.3% of children with two foreign-born parents have a documented diagnosis. This disparity is similar for other conditions and has a profound impact in access to treatment. Screening in primary care pediatrics is one mechanism for early identification of child risk behaviors; however, this process does not facilitate diagnosis as expected for Hispanic children. This is likely a function of the interplay between parental report of behaviors, validity of screening instruments in this population and provider diagnostic practices. While disparities for Hispanic immigrants and provider’s views are well documented, the mechanisms underpinning differences in diagnosis are not well understood. Additionally, parental perspectives on child’s behavior and diagnosis are insufficiently represented. Rich data on socioecological factors in the context of immigration and child health outcomes are not readily available and relationships are subsequently underexplored. Profound challenges related to resettlement in the United States contribute to risk for developmental-behavioral disorders. Apart from this direct relationship, these immigration-related factors influence how parent’s behavioral concerns develop and are represented on clinical screening instruments. For example, discrimination can increase risk for behavioral disorders in children while simultaneously impacting parent’s perception of these behaviors. This will subsequently affect how well screening instruments capture parent concerns. This study will quantitatively assess how these relationships contribute to diagnostic disparities. The study uses an adaptation of the Trajectory Model for Immigrant/Refugee Health to model relationships between socioecological factors, parent concern for behavior, screening results and clinical diagnosis. This conceptual orientation emphasizes structural contributions to inequalities while providing evidence to support improvements in clinical care for this population. This secondary analysis uses a community sample collected by PolicyLab Research Center at The Children’s Hospital of Philadelphia. Aim 1 will determine the relationship between socioecological clusters and parent reported child concerns. Aim 2 will assess concordance between parental concern and clinical screening results. Aim 3 will test the model proposing parental concern and screening as mediators of socioecological predictors of clinical diagnosis. Analytical strategies include cluster analysis, regression, and structural equation modeling. This study will provide foundational evidence to reduce diagnostic disparities for Hispanic immigrant children.

项目摘要 在美国，近五分之一的儿童存在发育行为障碍， 父母在初级保健访问中讨论的最常见问题。自闭症谱系障碍（ASD）是一种 这些条件，其特点是在社会和感官处理的差异。当ASD发生在 大约每53名儿童中就有1名被诊断为不同种族-族裔群体的儿童。白色孩子有 患病率最高（2.65%），西班牙裔儿童被诊断的可能性最小（1.94%）。此外，0.5%的 讲西班牙语的儿童和0.3%的父母都是外国出生的儿童有诊断记录。 这种差异在其他疾病中也是类似的，对获得治疗有着深远的影响。筛查 初级保健儿科是早期识别儿童危险行为的一种机制;然而， 并不像西班牙裔儿童预期的那样有助于诊断。这可能是一个功能的相互作用， 父母行为报告、筛查工具在该人群中的有效性和提供者诊断 实践虽然西班牙裔移民和供应商的观点的差异是有据可查的， 诊断差异的基础机制还没有很好地理解。此外，父母的观点 对儿童行为和诊断的影响没有得到充分的体现。丰富的社会生态因素数据， 移民和儿童健康结果的背景并不容易获得，随后 探索不足与在美国重新安置有关的深刻挑战增加了难民的风险， 发育行为障碍除了这种直接关系，这些与移民有关的因素 影响父母的行为问题如何发展，并在临床筛查工具上表现出来。为 例如，歧视可能会增加儿童行为障碍的风险，同时影响 父母对这些行为的看法。这将随后影响如何以及筛选仪器捕获 家长的担忧。本研究将定量评估这些关系如何有助于诊断 差距。该研究使用移民/难民健康轨迹模型的改编来建模 社会生态因素、父母对行为的关注、筛查结果和临床 诊断.这一概念取向强调结构性因素对不平等的影响，同时提供 支持改善这一人群临床护理的证据。该二次分析使用 社区样本由费城儿童医院的政策实验室研究中心收集。要求1 将确定社会生态集群和家长报告的儿童问题之间的关系。目标2将 评估父母关注和临床筛查结果之间的一致性。目标3将测试模型 提出父母的关心和筛查作为临床诊断的社会生态学预测因子的中介。 分析策略包括聚类分析、回归和结构方程建模。本研究将 提供基本证据，以减少西班牙裔移民儿童的诊断差异。